Primary prevention of cardiovascular disease: 2019 and beyond
Rhanderson Cardoso & Khurram Nasir 
Nature Reviews Cardiology (2019) | Download Citation

The global burden of cardiovascular disease morbidity and mortality demands increased awareness of effective prevention strategies by patients, communities and health-care providers. The new 2019 ACC/AHA guidelines provide evidence-based, preventive recommendations for patients without known cardiovascular disease, focusing on risk estimation, a healthy lifestyle and selective indications for pharmacotherapy.

As the leading cause of mortality worldwide, cardiovascular disease (CVD) accounts for approximately 18 million deaths annually.

A large proportion of fatal and nonfatal atherosclerotic cardiovascular disease (ASCVD) events occurs in patients without known CVD. Given that nearly half of patients with myocardial infarction and one-third of those who die from sudden cardiac death have no known coronary artery disease, an improvement in preventive efforts will contribute to a decline in CVD mortality. In this context, the ACC and the AHA put forth the 2019 guidelines on the primary prevention of CVD.

The guideline panel identified several key evidence-based strategies to prevent ASCVD in the adult population. Given that the prevalence of modifiable CVD risk factors remains elevated globally, the guidelines emphasize the importance of a healthy lifestyle for all individuals to promote well-being.

In the USA, fewer than one in five adults have five or more of the seven metrics of ideal cardiovascular health: no smoking, healthy diet, sufficient physical activity, optimal body weight, and ideal levels of blood pressure, blood sugar and cholesterol.

These risk factors are not only associated with the development of ASCVD, but also with heart failure, atrial fibrillation, cancer, depression and cognitive impairment.

The specific recommendations for a healthy lifestyle in the 2019 guidelines are summarized in Box 1.

In light of evidence from a meta-analysis showing that 12 individuals need to undergo repeated counselling to achieve recommended activity levels in 1 sedentary individual6, health-care providers must persevere in encouraging the implementation of lifestyle changes in all individuals.

Within the scope of risk factors, the 2019 guidelines highlight the pivotal role of social determinants of health in dictating unhealthy behaviours. These factors include housing or food insecurity, transportation difficulties, safety concerns, health illiteracy, caregiver burden and other psychosocial stressors.

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